Who cares for the caregivers?

[00:00:00] Gabriel Miller: Welcome to the Big Thinking Podcast, where we talk to leading researchers about their work on some of the most important and interesting questions of our time. I'm Gabriel Miller, and I'm the president and CEO of the Federation for the Humanities and Social Sciences. 

[00:00:22] Who cares for the caregivers? It's a question too important to ignore, especially after Covid-19 exposed how our society treats the immigrant care workers we rely on. I'm joined by Naomi Lightman, Associate Professor of Sociology at Toronto Metropolitan University, whose research focuses on migration, care work, gender, inequality, and critical research methodology.

[00:00:52] So for me, running through your research is a very clear commitment to understanding the experiences of immigrants to Canada, and particularly the experiences of people who've come here to do care work, which includes helping the sick and elderly meet some of their most basic needs. 

[00:01:19] Where my own kind of interaction with these issues first happened was years ago. My mother was very ill and she ended up being at home and being able to stay at home when she died. And what made that possible was in part a personal care worker who would come and visit us. And I still remember the day that we found out what she was being paid. And it was, I think it was a minimum wage, which at the time was six or seven dollars an hour. 

[00:01:44] And we were just, which isn't excused our not knowing, but we were really taken aback by the fact that someone who we were so relied on and, and needed to trust so much in such a difficult situation was getting such inadequate pay and support. When you look back at your own life, what stands out for you in terms of your own experiences that made you wanna do research in this area?

[00:02:15] Naomi Lightman: I've always been interested in issues related to gender and work and inequality, and I think my mother is really the reason I was first interested in this. She was a passionate feminist and she actually wrote the first book on sexual harassment in the workplace in Canada in the 1970s.

[00:02:33] So I really grow up, grew up talking about issues of gender inequality and my early memories are going to protests in Ottawa on International Women's Day. And just being really inspired by the passion and commitment to change that I saw around, around me. So I think that was my formative experience, thinking about these types of issues.

[00:02:57] But it was really during my PhD that I started thinking about care work in particular. I was reading all this sociological literature on gender and work, and what struck me was that care work was certainly a place where all those intersections of immigration, race, gender, class came into kind of stark relief.

[00:03:21] But in the Canadian context, the literature at that point was overwhelmingly qualitative. These were in our amazing qualitative pieces, tracing the stories and experiences of migrant women coming from poor countries to Canada, doing jobs that we know Canadians often don't wanna do in very poor working conditions, all the while trying to negotiate the immigration system and bring their families over.

[00:03:47] And I was struck by how unfair, this working, the, their working conditions were, but also the need for quantitative data to really document in a larger-scale way the labour market disparities that these women were experiencing. Certainly at the beginning of my career, my focus really was on quantitative documentation of labor inequalities for immigrant care worker women.

[00:04:10] Looking at it both in Canada and in international comparative perspective, because we really see similar things across wealthy countries in terms of these labour market disparities, and since then I've moved on to more mixed method research, I think some questions about care work lend themselves best to quantitative data and some to qualitative. 

[00:04:34] Gabriel Miller: Based on this work that you did in 2020 and 21, you published an article and I just wanna read a quote from it.In the introduction to your article, it says: “long-term care facilities have emerged as the single most critical location of the COVID-19 pandemic in Canada.”

[00:04:51] “In some Canadian settings, conditions are so bad that lawsuits have been filed, criminal charges may be laid, and the federal government has deployed military assistance for providing care.” What's so striking about your research is you chose to approach that situation through the experiences of a group of people who were intimately involved, but also largely overlooked. 

[00:05:18] Can you just tell us a little bit about what that research involved and how you got at, uh, what these women had experienced and also what ideas they could contribute to how to make things work better in the future?

[00:05:34] Naomi Lightman: It was one of the most meaningful projects I've ever worked on, and I think in part that was because it really was a true community collaboration.

[00:05:43] I was at the University of Calgary at the time, so our research was focused on Calgary and it was done with the Calgary Immigrant Women's Association, which is a non profit organization focused on assisting the employment opportunities of new Canadian women. From the inception of the idea that we wanted to interview immigrant women healthcare aids to thinking about our research questions, and even in thinking about how we were gonna share the results of our interviews, it was really done in collaboration with this organization, which made it that much stronger, I think, because it was grounded in kind of local concerns.

[00:06:24] More so than just an academic coming in and asking questions for a journal article. We did publish, or that journal article was published, but we also published a report through the Parkland Institute, which was co-authored and made widely available, at least to the Alberta Press at the time. So just in terms of that project, we did interview 25 immigrant women healthcare aids.

[00:06:48] So that is the term used there for personal support workers. And, in these interviews, we asked them about how their working conditions, their daily lives, their health and wellbeing, their families, how all of these different overlapping spheres of their lives had been impacted by the pandemic. And we also asked them what they would like to change.

[00:07:12] What they thought in terms of reforming the long-term care system to make it better for the workers, but also to make it better for residents and the people living within those long-term care settings. So I can certainly speak to some of the major findings that we had. The first being, and this will, I think, come as a surprise to no one, but that there were really harsh financial implications for the workers of the pandemic. 

[00:07:38] And one of the main reasons for this was that there was a single site work policy that was instituted in long-term cares in Alberta. There was also one instituted in Ontario, I'd note around the same time. Overwhelmingly, the women I spoke to had been working two or more jobs in order to make ends meet.

[00:07:57] In some cases, this was because they had multiple part-time jobs and weren’t able to get a full-time permanent position. In some cases it was because they weren't making enough from a permanent job and they, especially if they were sending money back to family members in their home countries, so they were working really long hours.

[00:08:13] That was their choice. That was their financial strategy. In a low wage, oftentimes precarious job, and so many of these women estimated that their earnings had gone down 40 to 70% because of this policy. But they also talked about other things. They talked about, for example, physical and mental health challenges that had been [...]

[00:08:38] I'm reluctant to say um created by the pandemic, I would say exacerbated by the pandemic. There's a lot of research that shows, of course, prior to the pandemic, this was very physically difficult work, there's a lot of lifting of residents and cleaning. It's a very physical job. And also mentally it's very draining, especially when there aren't enough resources available or the staff to resident ratio is very high.

[00:09:04] A lot of the women, for example, talked about not being able to provide the care they wanted to because there simply wasn't enough time given their, given the staff to resident ratios where they worked. But of course Covid did add to this, but in addition to that, certainly they talked about the stress. The stress of watching people in some cases die in very rapid succession and in large numbers also just get very sick. 

[00:09:31] Also, the stress of potentially infecting their family members or getting sick themselves. Yeah, and that was obviously something that weighed very heavily on them. I know at the same time they talked about experiencing racism and sometimes violence from residents in some cases. And we know there was widespread anti-Asian racism going on during the pandemic, and that was another thing they had to handle.

[00:09:58] A surprising number of women talked about people, about residents suggesting that they had brought the virus into that long-term care home, and you can imagine how difficult that was for them to navigate while they were also doing these very demanding jobs. The women certainly had many ideas about what had gone wrong during the pandemic from an, from a management level, and largely they critiqued what they perceived to be a prioritization of profits over quality of care.

[00:10:28] And it did look and sound a little different in kind of private or for-profit long-term care institutions, but nonetheless, the women talked about not having enough PPE (personal protective equipment). We know that was widespread across long-term care facilities really worldwide.

[00:10:50] But again, they, they also talked about the reluctance to have full-time permanent employees was often a cost saving measure by management, because of course the same benefits don't need to be provided. And your staff is only temporary or part-time and they, they were concerned about using kind of temp agencies, which is a real growing trend. Actually the entire care market, but also specifically in long-term care. 

[00:11:10] And this has issues in terms of consistency of care, which is so important for elderly residents or people dealing with dementia. I think this led to their concerns that they had really been left out of decision making, and that was something that we heard again and again. So they did see that there was an, there was a need for an increased role for healthcare aids in all levels of decision making regarding the regulation and investment in long-term care settings.

[00:11:41] Gabriel Miller: Was there anything in the experience and in the results of this study that surprised you? 

[00:11:50] Naomi Lightman: I think that how much they had been suffering financially was surprising to me. I had already done a lot of research that documented that they made less than comparable workers. Any of them experienced intersectional labour market disadvantages.

[00:12:03] Their disadvantage for being a woman, for being an immigrant, for working in a feminized occupation. But to think that on top of that, they were now making 50% less than they had before. That was really surprising to me and really, yeah, really upsetting. 

[00:12:20] Gabriel Miller: One of the things that I'm left wondering about, as I read your work and reflect more on this situation, is this: what seems like a contradiction in our relationship to long-term care and to these healthcare aids in particular, which is we rely on them to provide care for people in their most vulnerable moments.

[00:12:44] And in forms that are vital to everybody: bathing, using the toilet, eating, getting dressed, staying connected to any kind of community within the facility where someone lives. We can all imagine our own family members or ourselves arriving at a time in our lives where we'll need this kind of care.

[00:13:12] And yet, there seems to be an almost pathological inclination to under-appreciate it and to marginalize it. And I guess my question for you is, having looked at this and having spent your career so far, so much immersed in issues related to this, what's that about?  

[00:13:35] Naomi Lightman: I think that's very well put. It is almost pathological the way we devalue this labour and certainly have thought a lot about why that's the case and so have many other feminist authors of care work.

[00:13:48] And at a very basic level, I think it is because we associate it with quote unquote “women's work”. These are jobs that traditionally were done by women at home or at work for, but oftentimes at home for free, right? For children or elderly people or sick people, or at least lower middle class women anyways, and I think that translates to when we've marketized these jobs of caring for sick, elderly, young people.

[00:14:18] We just don't value it the society in the same way as we do other jobs. For those who might be skeptical of this, there is data that documents this. My research really does show that we take people with exact or very similar profile, same education, same language proficiency, same skillset, same training. And we see comparable jobs, and we almost always find that working in the fields of health and education, the low wage sectors of these fields make less than comparable workers.

[00:14:51] And, the more you look, the more you see the same. I'm actually working on a paper right now where I'm looking at 18 countries, so that includes North American countries, Western Europe, southern Europe, even central and Eastern Europe country, Eastern European countries, and it's the same trench. We see that these jobs make less than comparable workers, comparable jobs, and we see that it's immigrant and racialized women that are doing these jobs.

[00:15:16] So yeah, I guess my hypothesis is it's related to the feminization of these jobs and, and the fact that we don't see it as comparable work to more masculinized occupations. It's hard to reconcile that as you're suggesting with the reality that we're all gonna rely on people to help us with care work in our lives, someone we pay to help us care for our child, either at home or at a daycare. Or whether it’s when we go to the hospital when we're sick.

[00:15:46] Or when it's, if it's when we're old or we're thinking about the care of a loved one who's elderly and vulnerable, but somehow that doesn't translate to actual changes in terms of the working conditions of people who are helping us in that way. 

[00:16:01] Gabriel Miller: Are you seeing, uh, examples of policies or changes that are, that are helping or could help us start to transcend these self-defeating attitudes when it comes to care work?

[00:16:17] Are there examples in your own experiences from specific institutions or in your research about other countries where they're managing to start to overcome these biases so that they can do a better job of supporting the people who are doing this work?

[00:16:39] Naomi Lightman: I think we do see that in countries or in provinces where there is more of an emphasis on public provision of health and childcare. And similarly we see in places where there's more oversight in terms of inspection of long-term care sites, that's real inspections that can make a difference. I think that there is more of a conversation of needing to support the mental health of healthcare workers.

[00:17:07] Really internationally after the pandemic, that's something that perhaps will also be the case for those that are at the lowest wage workers within the healthcare system because certainly, mental health of doctors and nurses has become something we're hearing a lot about. Um, I think focusing on employment conditions, I do think that governments can play a role in this in terms of how funding is provided, prioritizing full-time, permanent employment in these jobs, raising hourly wages, not supporting the use of temp agencies.

[00:17:39] Mandating paid sick leave days, even having universal childcare, that makes a difference. These women are mothers for in large parts, making sure high quality, accessible childcare, transportation systems. All of these, I think, can have major differences on the working conditions that these women experience.

[00:17:57] So things that I would suggest are good for society overall are going to also have benefits, especially for the most vulnerable members of our society. It's one thing to, to think more broadly how we can tackle like racism and gender discrimination, but I think at a very applied level, we need to make these jobs better.

[00:18:16] Jobs that are better paid, that are better supported, and that's gonna have measurable, meaningful differences in the livelihoods of these vulnerable workers.  

[00:18:26] Gabriel Miller: I know as a researcher, you are taking the insights and experiences that you've had through your own research during the pandemic and before it, and asking where that research needs to go.

[00:18:42] How do we, what are the questions that need to be asked and answered more broadly about the way we provide care about the support and perspectives of the people who provide that care. What questions are you most excited about working on now and into the future in this area? 

[00:19:03] Naomi Lightman: Yeah, there's really two areas that, that I'm looking into now.

[00:19:07] The first is actually thinking about more of a life course analysis for migrant care workers. So I, I've just published a paper on this topic, but I'm doing more research really focused on the experiences and financial outcomes of care worker immigrant women as they age, because I think that they're working often times with aging populations, haven't known very much about whether they have savings.

[00:19:34] If and when they're financially able to retire. We know there's disproportionate poverty among senior racialized populations, specifically in urban centres in Canada, but we really don't know if immigrant care workers are able to age with financial security, with adequate social protection. So that's something I think needs to be top of mind.

[00:19:53] Given generally our aging population, but also just that this is another kind of basic right that we should be assuring for people doing these very difficult essential jobs. And yeah, my most recent paper with my colleague Hamid Akbary, we really found that women who had come through the federal caregiver entry stream, experienced a total individual income decline with age after age 65.

[00:20:21] And this is even accounting for old age security benefits. Um, their pension plans and any private pension income, if they have any, but many do not. So this really suggests we need to rethink things like our old age security, our guaranteed income supplements, and assure that again, women doing these jobs that conceptually we think are so important are also able to age with financial security and dignity.

[00:20:45] The other one is, I guess, more similar to the project I did in Calgary looking at long-term care, but this is gonna be a mixed method project with Social Planning Toronto, which is another nonprofit community agency, and we're going to be interviewing immigrant women.

[00:21:07] Support workers, to the same population but those that are working in home care. So we know that conditions, working conditions are worse when you're in private homes than they are in institutions like long-term care homes because there's so little oversight, it's harder to unionize when people aren't working in the same, in a physical location together.

[00:21:27] Not impossible, but harder. And you're very vulnerable to abuse. Wages are very low, a lot of challenges in terms of all the commuting you need to do: driving to people's homes, taking TTC (Editor’s note: Toronto Transit Commission). So we're gonna be interviewing we're, we've just put in our ethics application here and we're gonna be speaking to PSWs (Editor’s note: Personal support worker) in Toronto, but we're also going to be talking to representatives from community and labor organizations who are engaged in related policy and organizing work.

[00:21:57] We're gonna be asking them certainly to reflect on the pandemic and how that impacted their working conditions, both during the pandemic and now as we're in the process hopefully of coming out of it. But we're also gonna be asking them about what opportunities they think exist to increase their own work worker power, and collectively make changes to improve their working conditions.

[00:22:23] This is another area, again, I think home care. We can't think about it enough since it's perhaps the most vulnerable site of work a person can be in when it's someone else's home.

[00:22:34] Gabriel Miller: It’s encouraging to hear that you're going to continue keeping such a focus on care provision and the people who are doing it, and also that you're gonna be looking at home care.

[00:22:47] Do you feel like the possibility of organizing, of having a stronger kind of community representation for the folks in who are providing care is viable and, uh, an important part of improving this situation in the future?

[00:23:06] Naomi Lightman: Absolutely. I think that organizing always holds potential. It's difficult, it requires a lot of moving parts to be in play, and of course you could organize as much as you want, and sometimes it just doesn't leave to lead to changes.

[00:23:20] But I think there, there has to be hope that collective action by these workers can improve their conditions. Also, I think, understanding that we all do have these personal stories that intersect with the lives of care workers means that we're also culpable to be fighting for improving work, improved working conditions.

[00:23:41] And, you know, you shared that personal story, it makes me think, I just recently became a mother and so I'm thinking now about childcare in a way. I've been studying it for years, but of course, all of a sudden it becomes much more immediate. And similarly, it's almost funny, but I was added by a friend to these Facebook groups that are for moms in Toronto looking for childcare.

[00:24:04] And so I've just been passively watching what's going on there, and it's really outrageous. People asking for someone to come to their home for eight hours a day, care for their three children, do housekeeping, cook meals, and they're offering $20 an hour, and perhaps that's all they can afford. It is a structural problem.

[00:24:27] But it’s really devastating to watch that. And then also seeing that for many people, this is, people are accepting those jobs because they need work. That's the best job that's available to them. And you know, people explicitly saying that they want all these things, but they're not able to sponsor this person for permanent residency.

[00:24:43] That also really strikes me, so I think we can't focus on the individual, it's just that these individual stories are sometimes what make us have the strongest feelings about how unfair and how inequitable the situation is. But what we need is structural change. We need more publicly provided childcare so that there are good jobs within childcare institutions and people looking for childcare can access them.

[00:25:09] So yeah, I think we're all responsible for trying to make change because it is something that touches us all personally.

[00:25:21] Gabriel Miller: Thank you for listening to The Big Thinking Podcast and to my guest, Naomi Lightman, associate Professor of Sociology at Toronto Metropolitan University. I also want to thank our friends and partners at the Social Sciences and Humanities Research Council, whose support helps make this podcast possible. Finally, thank you to CitedMedia for their support in producing the Big Thinking Podcast. Follow us for more episodes on Spotify, Apple Podcast and Google Podcast. À la prochaine!